Orthotics For Children And Pediatric Orthotic Applications
20 Feb 2017
There are many unique aspects of providing orthotic devices to children. From a biomechanical and assembly perspective, working with young patients draws largely on the same orthotic principles and materials as with adults; indeed the spectrum of orthotic appliances includes relatively few systems designed specifically for pediatric applications.
Kids present unique opportunities and challenges. The overall goals are familiar: prevention and/or correction of deformities and functional improvement.
While desired outcomes sometimes can be achieved with scaled down versions of adult appliances, providing pediatric orthoses calls into play certain skills and considerations that add complexity to the process but offer commensurate professional reward.
Here are some special considerations we encounter in managing children:
• Custom vs. off-shelf. While some popular devices such as the Pavlik Harness, orthopedic shoes and night splints are primarily prefabricated components, pediatric orthoses tend to be custom made because of the reduced tolerance for error corresponding to the child’s stature and smaller area on which correctional forces can be focused.
• Growth. The propensity of a child’s bones and muscles to grow non-synchronously challenges orthotists to incorporate assembly features that will sustain productive orthotic forces over time while maintaining range of motion…and at the same time remaining on speaking terms with parents, HMOs, and others who write the checks.
• Developmental age. Each child presents with his/her unique combination of motor development, cognitive and adaptive function, and learning ability (possibly retarded by disease process). This set of variables challenges orthotists to provide componentry suited to the patient’s capacity to benefit from it.
• Communication. Very young and some older developmentally impaired children are often unable to verbalize pain or describe problems with the way an orthosis fits or feels. Further, young patients cannot be expected to understand or remember details of application, schedule, skin care, orthosis care, etc. Thus, the orthotist is called on to employ special skills of observation and communication with the child and parents to realize the intended benefits from orthotic intervention.
• Weight. Plastics and other synthetic materials are typically chosen over metal and other heavier choices to make the orthosis as absolutely lightweight as possible. Minimizing weight while incorporating sufficient durability to withstand the stresses imposed by an active child adds to the challenge.
• Finishing Enhancements. Colorful, creative finishing, as with cartoon or action figures, can make orthosis wear significantly more acceptable to a younger child. Other techniques—designing braces to be worn under clothing or to fit into normal-appearing shoes – enhance body image and therefore acceptance among older, appearance-conscious pre-teens and adolescents.
• Family Support. Though a child’s abilities, viewpoint and responses will vary significantly from infancy to adolescence, active parental and family participation in the orthotic intervention remains critical throughout. Few pediatric patients can be expected to carry out the at-home portion of the orthotic plan independently. Our orthotic staff is well-trained and experienced in working with pediatric patients. We invite your inquiries and referrals.
From Tip to Toe, Specialized Orthoses Support and Direct Childhood Development
The following selection presents a cross-section of orthotic componentry employed in contemporary management of pediatric patients. While some also have adult applications, the majority of these designs are primarily prescribed for children. If you have an interest or questions regarding a particular orthosis presented, or excluded, here, please call our office.
Ankle Foot Orthosis (AFO)
Application: Varum and valgus deformities.
Description: Custom-fabricated thermoplastic, metal or composite device designed and trimmed for patient’s unique needs.
Function: Provide proper alignment, limit or encourage ankle motion.
Application: Tight hip adduction secondary to spastic diplegic cerebral palsy.
Description: Custom-molded thigh cuffs connected to adjustable aluminum joint.
Function: Control adductor tightness, leg scissoring.
B-Hip Abduction Orthosis
Application: Children age 3-12 months with hip dysplasia or a hip subluxation.
Description: Lightweight plastic orthosis consisting of an abdominal strap and thigh cuffs connected to a posterior plate by straddle bars.
Function: Maintains hip at 90 degrees of flexion and 60 degrees of abduction to promote proper femoral head and hip development.
Cranial Remolding Orthosis
Application: Positional or deformational plagiocephaly, brachycephaly, scaphocephaly.
Description: Custom-molded plastic foam helmet.
Function: Redirect cranial growth to correct facial and skull asymmetry.
DAFO – Dynamic Ankle Foot Orthosis
Application: Cerebral palsy, hemiplegia, spastic diplegia.
Description: Thin, flexible molded thermoplastic orthosis covering the entire foot; custom contoured footplate; designed to distribute weight-bearing forces over large area.
Function: Reduce ankle hypertonicity, increase ankle stability and provide proper alignment.
Floor Reaction Orthosis
Application: Cerebral palsy “crouch gait,” knee instability.
Description: Rigid thermoplastic or laminate AFO with neutral ankle position and a broad anterior panel just below the knee.
Function: Apply knee extension moment during stance phase to prevent knee buckling and excessive flexion associated with crouch gait.
Knee-Ankle-Foot Orthosis (KAFO)
Application: Hemiplegia, diplegia, lower limb instability and deformities.
Description: Primarily thermoplastic laminated brace extending from thigh to footplate, typically incorporating a knee and/or ankle joint.
Function: Control motion and alignment of the knee and ankle.
Maple Leaf Hip Abduction Orthosis
Application: Cerebral palsy, ages 4-12.
Description: Anatomically contoured thermoplastic lumbar-pelvic section connected to thigh cuffs by adjustable locking joints.
Function: Maintain length of involved musculature and control or prevent recurrence of deformity after soft tissue release or related hip surgeries.
Non-Invasive Halo Vest
Application: Positioning of structurally stable spine after complications of standard halo immobilization, C1-C2 rotary instability, torticollis.
Description: Pinless, MRI compatible HALO headpiece and vest with rigid or semirigid back post component.
Function: Cervical spine immobilization and control.
Application: Paraplegic patients 3 years and older, spastic cerebral palsy, myelomeningocele
Description: Aluminum frame incorporating thermoplastic footplate, foam knee block, hip and knee locks, and chest and back panels. Three-point system keeps patient upright.
Function: Enable paraplegic children to stand without crutches; prevent or reduce flexion contractures. Those with good torso control can achieve pivot gait and independent mobility.
Application: Hip dysplasia, including congenital hip dislocation, in infants of pre-walking age.
Description: Shoulder harness with anterior and posterior straps extending from chest strap to stirrups.
Function: Hold hip in flexionabduction attitude while allowing for movement within acceptable limits.
Reciprocating Gait Orthosis
Application: Lower-body neurologic impairment: Indicated in L1 to L3 lesions in children with functioning iliopsoas and hip adductors.
Description: HKAFO incorporating cable system or similar method of mechanically translating hip extension on one side into hip flexion on the contralateral side.
Function: Provide standing and ambulation ability, thereby raising physical and psychological horizons.
Application: Idiopathic scoliosis.
Description: Thermoplastic TLSO.
Function: Limit curve progression and need for surgical correction.
SWASH – Standing, Walking and Sitting Hip Orthosis
Application: Cerebral palsy; any child whose adduction and/or internal rotation at hip joint interferes with function or induces lateral migration of the femoral head.
Description: Plastic padded waistband and two joint assemblies connected by shaped leg bars to adjustable plastic thigh bands.
Function: Stabilize hip and oppose excessive adduction and internal rotation; reduce scissor gait while walking and improve balance while standing.
Application: Congenital muscular torticollis/sternomastoid torticollis.
Description: Custom-molded helmet and shoulder sections connected by multi-planar adjustable joint.
Function: Maintains head in any desired position, including rotational and longitudinal adjustments, post-sternomastoid release surgery.
Wheaton Brace – KAFO (Tibial Torsion Orthosis)
Application: Metatarsus adductus, clubfoot, tibial torsion; used in place of serial casting or corrective shoes.
Description: Molded thermoplastic and Velcro knee-ankle-foot orthosis.
Function: Applies direct corrective rotational force on the tibia without any torque on the femur or hip.